MSc. Dt. Özgecan KÜÇÜKKURT
Prosthetic Dentistry Specialist
SMILE DESIGN
Smile design is to plan and create the ideal smile for you by combining some of your personal wishes with health, naturalness, and function.
Your smile says a lot about you. Studies show that your smile is often the first place people look when they meet.
In a dissonant smile, your eyes immediately focus on the person's teeth, and subconsciously you try to find the reason for the inappropriateness of that person's smile. We all do this; it's part of our social nature. In a pleasant smile, however, your brain registers that person has a pleasant smile, and we direct the attention to their eyes. Nothing expresses personality, energy, and confidence like a healthy and luminous smile.
In short, your smile is your self-confidence.
If you say yes to one or more of the questions below, you need an aesthetic dentistry practice.
• Have you ever wanted to have someone else's smile?
• Do you try not to show your teeth or cover your mouth with your hand while smiling?
• Do you avoid smiling while taking a picture?
• Is there anything in your smile that bothers you?
• When you smile with a wide-open mouth, does your upper lip go up to show your gums too much?
• Do you think the treatments (fillings, crowns, etc.) on your teeth differ from your natural teeth (color, form, etc.)?
• Would you like your teeth to be whiter?
• Do you have crowding and/or irregularities in your teeth?
• Do you have gaps between your teeth?
• Do you have many fillings or fractures in your front teeth?
• Are there any annoying level and size differences between your front teeth?
How to make a smile design?
A clinician focused on aesthetic dentistry should first make the following evaluations before applying to his patient;
Factors Affecting Your Smile
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Face Analysis
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Face Ratios
The vertical and horizontal lines imagined crossing a person's face give mathematical values used in symmetry and size calculations. Although it is not always possible to fully comply with these values, this is one of the references used in the initial phase.
Age
Today, many products and applications make us look younger. (Anti-wrinkle creams, cosmetic materials, skin stretching operations, etc.) Rejuvenating the smile is one of the most effective of these applications.
If we look carefully at our smile, we will see that our teeth are darker than when we were young and have lost their shine. This is because cigarettes, tea, coffee, and red wine that you have used for many years, and sometimes the erosion of the tooth's enamel layer causes your smile to become discolored and indistinct over the years. If that's the only problem, you can create impressive changes with a simple whitening procedure. But most of the time, just whitening your teeth is not enough. Your smile can be optimized with composite bonding, porcelain veneers, and crowns. This change is so much that people around you can only notice a positive difference in you. They think you have changed your hair and lost weight, but they cannot catch the significant change in the teeth. Because the treatments should be not only beautiful but also wholly compatible with your face.
As we age, our smile shrinks. Our upper lip collapses with the effect of gravity, and the vermillion border (inside of the lip) becomes thinner. Over the years, our teeth have worn down. The nose tip to the chin tip distance approaches each other. In other words, the lower 1/3 of the face is shortened. The soft tissues in the lower 1/3 of the face are supported by the jawbones and teeth. The height that occurs when we close our teeth (especially the back teeth) is significant for this support. Over the years, our jaw bones become thinner, our teeth wear down, and this distance becomes shorter. This causes you to be unable to chew well enough, and the soft tissues that determine your smile to sag and not be adequately supported. Wear on the teeth becomes more evident after age 40 and is very common. The teeth quickly shorten and often break if there is also a problem with clenching and grinding. The teeth begin to look deficient and unable to perform their function. In addition, issues start to occur in the jaw, making the person look older.
Teeth appear approximately 1 mm less every 8-10 years, so by age 70, there are hardly any teeth visible when immobile. Every 10 years, there is a 15-20% loss of vision in a person's smile.
If such a problem occurs, the solution is porcelain onlays covering the chewing surfaces and porcelain laminate veneers in the anterior region. With these, both aesthetics is provided, the loss of distance caused by the shortening of the teeth is corrected, and the lower 1/3 of the face is brought to the required size. This way, a smile lift is performed by rejuvenating the lips, reducing the lines around the lips, and making the teeth appear more. Some call this process dental antiaging. This process widens the smile and makes you look younger.
Gender
There are significant differences between male and female smiles. Some of these are those;
1. Face shape
In natural teeth, there is a similarity between the shape of the face and the shape of the teeth. In other words, if you have an oval face, the condition of your teeth is oval or very close to an oval. Therefore, we can achieve natural smiles by using this harmony in our aesthetic applications.
Sometimes we use cosmetic illusions to disrupt this harmony. For example, the person's face may be square, round, or long enough to disturb him. Considering this discomfort while designing the smile in such people, the pain in the face shape can be reduced with the new smile by changing the shape of the teeth.
For example, if a person with a long face shape is made with thin and long teeth, his face will appear longer than it is. In this case, the length of the face can be hidden by using wider square teeth, or thin and long teeth applied to a patient with a very round, fat face will make a positive difference in the general appearance of the face.
2. Skin color
In aesthetic dentistry applications, the designed smile must match the person exactly. Because even very well-prepared teeth sometimes cannot add anything to the face; on the contrary, it disturbs the eye. Therefore, skin color is one of the most essential factors in determining the application's color. While very light-colored, bright, remarkable teeth cannot provide a pleasant and beautiful smile in people with a dark skin color, these teeth look more natural and harmonize with the smile in people with lighter skin tones.
Dental Analysis
Dental conditions and problems such as tooth axes, tooth length, tooth color, form, and midline should be determined. When the filtrum is used as a reference, it has been shown statistically that the maxillary midline coincides with the facial midline in 70% of cases. Midline shifts up to 4 mm are not noticeable as long as they are perpendicular to the interpapillary line.
Applications in aesthetic dentistry vary according to the problems in the form and color of the teeth.
If there are spaces between the teeth (diastema): Diastema can be treated in 3 ways;
1. Orthodontic treatment
2. Treatment with composite fillings
3. Treatment with laminate veneer application.
If the color of the teeth is dark: (Tetracycline or Fluorosis discoloration)
The process to be done changes according to the level of the amount of coloration. The first thing to try is whitening. If the desired color cannot be achieved (in some cases, the teeth do not react well to the whitener or the color is too dark, and suitable whitening cannot be executed), one of the treatments to be done is porcelain laminate veneers. In cases with severe tetracycline discoloration, the procedure may be whitening first and then laminate veneers. The color of the adhesion cement of laminate veneers also affects the light and color reflected by the laminae.
If the teeth are crooked:
The first thing to do is orthodontic treatment. If the patient absolutely does not want orthodontic treatment or if the orthodontic treatment is not suitable for the patient for various reasons, in some cases, crowding can be corrected with laminate veneer application.
If there are abrasions and fractures in the front teeth:
One of the most aesthetic and long-term solutions to get rid of them is porcelain laminate veneers. Your teeth will be protected against external factors, and you will have a beautiful smile. If the fractures in your teeth are caused by the problem of clenching or grinding, it is necessary to make dental plaques called night guard after laminates are made.
If there are many badly colored fillings in the front teeth:
The cheapest and most accessible treatment that can be done is the renewal of composite fillings. However, there are limitations due to the nature of the material. So, even if a nice filling is made, if you smoke too much coffee or tea, smoke, or your oral hygiene is not good, the fillings will absorb the colors in a year or two, and the edge leakage problem will arise. In such cases, porcelain crowns or laminates can be preferred.
Phonetic Analysis
The dentist will do your phonetic analysis by asking you to make sounds like I, EM, and S. Problems that may arise in this analysis are sometimes caused by tooth positions. Treatment can be performed by correcting these positions.
Gum Analysis
Ideal gingiva
• Healthy and elastic in light pink color,
• Not very thin biotype,
• Symmetrical, visible as needed on the smile line,
• With zenith points located in the right place,
• The gingiva is ideal if there is no papillary or minimal papillary loss.
Even the most beautiful teeth cannot look attractive if they are not framed by healthy and properly shaped gums. Non-aesthetic gums can be corrected with treatments and minor operations on your gums.
Unhealthy gums: The gums appear red, swollen, and shiny due to periodontal disease. They must be treated before aesthetic dentistry procedures.
Gingival recession: Because of gingival recession, some teeth may appear very long, exposing their root surfaces. These openings can be closed with periodontal surgeries using soft tissue grafts and performing gingival treatment first.
Irregular gingival edges: The gingival framing of the teeth may be too high or too low in some teeth (gingival recession, eruption disorder, defects arising from tooth loss, etc.).
Gingival pigmentation: There may be different colored areas in the gums due to any injury or natural. Their removal positively affects aesthetics if they are on the laughing line.
Lip Analysis: High or low lip lines can cause aesthetic problems. Therefore, the clinician designs the smile by performing all lip analyses before the treatment. The support of the teeth to the lip and the incisor teeth position is among the most essential factors in creating a smile. Therefore, the lip-tooth relationship is significant in the smiling place. Up or down the edges of the lips can completely change the expression.
Smile with gums (Gummy Smile) reasons:
• Hyperactive lip
• Insufficiently erupted teeth
• More vertical development of the upper jaw than normal
In treating a gummy smile, the cause should be determined first, and the treatment should be planned accordingly.
Techniques Used in Smile Design:
Orthodontics: Using various techniques, orthodontics brings one's teeth into the correct sequence and closure. Today, porcelain brackets or clear aligners placed by the tongue and transparent plaque applications are used effectively together with metal brackets that have been used for a long time and adhered to the tooth's outer surface.
Porcelain Laminate Veneers: Thin porcelain leaves adhered to your teeth provide profound changes. It is the most used technique in aesthetic dentistry. Because it creates significant changes by removing little or no substance from the tooth. It is impossible to distinguish it from a natural tooth because it has a light transmission feature.
Whitening: It makes the natural color of your teeth whiter and brighter. It eliminates the discoloration caused by trauma, old age, and various drugs.
Bonding (composite filling): Fills gaps, repairs fractures, and covers discolorations with advanced materials compatible with enamel. It is inexpensive and easy to apply but has a limited lifespan.
Porcelain crowns (veneers) without metal support: It is applied too heavily to damaged or previously cut teeth to improve appearance and health.
Cosmetic Contouring: Shaping is done with tiny abrasions and small composite additions so that your teeth can be seen properly and correctly.